MARYLAND WATER QUALITY FINANCING ADMINISTRATION (MWQFA) APPLICATION FOR FFY 2018/STATE FY 2020 CAPITAL PROJECT FINANCIAL ASSISTANCE WATER QUALITY IMPROVEMENT PROJECTS (i.e. (WASTEWATER) AND NONPOINT SOURCE)

For assistance, please contact Elaine Dietz at elaine.dietz@maryland.gov

All Applicants:

Projects submitted will be rated, ranked and listed on a Project Priority List (PPL). The draft PPL and the draft Intended Use Plan forWater Quality State Revolving Loan Fund (WQRLF) will be available in April/May 2018 for public review/comment. Applicants will benotified by email of draft PPL/Intended Use Plan availability. Projects for which State grant funds are requested will be included in theGovernor’s Capital Budget presented in January 2019 during the Legislative Session; official notice of grant funding will be made inSpring 2019.

WQRFL and State grant funds are generally available on July 1 of the State Fiscal Year specified on the application; however, MDEwill not take projects to the Board of Public Works (BPW) to encumber funds until all applicable requirements are met and typically notuntil construction bids are approved. Loan closings are scheduled following BPW approval.

All projects receiving State and/or Federal funding are required to comply with Minority and Women Business Enterprise (grantonly projects) and Disadvantaged Business Enterprise (WQRLF projects) participation requirements. Please visit the followingwebsite: M/WBE and DBE Guidance for requirements, threshold levels, and forms.

Submit two (2) signed hard copies and one CD or flash drive of the complete application, attachments, and all supporting documentsNO LATER THAN JANUARY 31, 2018 to:

Ms. Elaine Dietz Maryland Water Quality Financing Administration

Maryland Department of the Environment Montgomery Park Business Center 1800 Washington Boulevard, Suite 515

Baltimore, MD 21230-1708

Regarding Water Quality Revolving Loan Fund (WQRLF):

The WQRLF program can now provide loans up to 30-year term (not to exceed the asset’s useful life).

Requesting that a project be considered for WQRLF funding does not commit the applicant to take a loan.

Projects for WQRLF consideration will also be considered for loan principal forgiveness based on policies detailed in the Water Quality Funding Subsidy Chart. Loan principal forgiveness (if eligible) is not offered without loan.

Interest rate for a project is based on the average of the Bond Buyer 11-Bond Index for the month preceding loan closing. Rates areposted on the Interest Rate page of our website and updated monthly.

Publicly-owned treatment works projects funded with WQRLF are required to comply with the Federal prevailing Davis-Bacon wagerates, apply the American Iron and Steel (AIS) provision, and undergo an environmental review (by MDE) of the potentialenvironmental impacts.

Recipients of WQRLF must obtain a Data Universal Number System (DUNS) number, which is a unique nine-character identificationnumber provided by D&B. Information regarding the DUNS number is located at D&B D-U-N-S Request Service website.Additionally, WQRLF recipients must maintain project accounts according to Generally Accepted Accounting Principles as issued bythe Governmental Accounting Standards Board.

Public entities applying for a WQRLF loan in excess of $400,000 should declare official intent for reimbursement of costs the applicantwishes to be compensated for from tax-exempt debt (including a loan from MWQFA) prior to making any expenditure associated withthe project. The Administration advises the applicant to coordinate those efforts with MDE and local/borrower’s bond counsel toensure satisfaction of WQRLF loan requirements and IRS regulations.

Page 1 of 8 MDE/BIF-FIN001 TTY Users 1-800-735-2258 FFY 2018 & State FY 2020

MARYLAND WATER QUALITY FINANCING ADMINISTRATION (MWQFA)

APPLICATION FOR FFY 2018/STATE FY 2020 CAPITAL PROJECT FINANCIAL ASSISTANCE WATER QUALITY IMPROVEMENT PROJECTS (i.e. (WASTEWATER) AND NONPOINT SOURCE)

For assistance, please contact Elaine Dietz at elaine.dietz@maryland.gov

PROJECT INFORMATION (Attach a copy of a current street map with the exact project location clearly marked.) Project Name:

Project Address: (Provide for location of the funded activity. If project spans large area, enter street address (9-digit Zip Code required) that best represents center of project area)

County: Latitude: (00.000000) Longitude: (00.000000) See Convert Project Address to Latitude/Longitude for help.

Congressional District: See Supplementary Mapping Instructions for help.

Legislative District: See Supplementary Mapping Instructions for help. River Basin Designation: Provide the numeric eight-digit watershed designation according to the project location (for wastewater treatment plants, identify according to the permitted point of discharge). See Supplemental Mapping Instructions for help.

Watershed Name Eight-Digit Designation - - - APPLICANT INFORMATION Applicant Name: Applicant Address: (incl. 9-digit Zip Code)

County: Email: Phone: Ext: Federal Tax Identification Number: CONTACT INFORMATION Contact Person: Title:

Contact Address: (incl. 9-digit Zip Code)

Phone: Ext: Email:

APPLICATION TYPE (Review the Water Quality Funding Eligibility Chart and select ONE of the following.)

[ ] Consider this project for best possible MDE funding package, including Water Quality Revolving Loan Fund (WQRLF) low-interest loan (with partial loan principal forgiveness, if eligible) as well as Bay Restoration Fund Wastewater Grant. See cover page for additional information.

[ ] Consider this project for Bay Restoration Fund Wastewater Grant funding only. Applicant will assume financial responsibility for balance of project costs.

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I. WATER QUALITY PROJECT TYPE [Check appropriate project type.] (If the project scope consists of multiple types, it should be split into separate projects with one application submitted per type.) Publicly-Owned Treatment Works (POTW) Projects

[ ] Upgrade of existing wastewater treatment plant (WWTP) at current design capacity (no expansion) Current Design Capacity (mgd): Current Treatment (Secondary, BNR, ENR):

[ ] Upgrade of existing WWTP with expansion

Proposed Treatment (BNR, ENR):

Current Design Capacity (mgd): Expansion Capacity (mgd):______________________ Current Treatment (Secondary, BNR, ENR): _______________ Proposed Treatment (BNR, ENR): ________________

[ ] New WWTP construction Proposed Treatment Capacity (mgd) ________________

[ ] Sewage inflow/infiltration correction

[ ] Combined sewer overflow/sanitary sewer overflow correction

[ ] Repair/rehab existing sewerage collection system

[ ] New sewerage collection system for existing onsite septic area

[ ] New sewerage collection system for new development

[ ] Non-hazardous landfill leachate collection/conveyance/treatment

[ ] Construct/repair/replace decentralized/community wastewater treatment systems

[ ] Measures to reduce demand for POTW capacity through water conservation, efficiency, or reuse

[ ] Measures to reduce energy consumption at POTWs

[ ] Measures to increase the security of POTWs (note: guards/monitoring activities are ineligible)

Non-Treatment Works Projects [ ] Municipal landfill capping

[ ] Measures to manage, reduce, treat, or recapture stormwater or subsurface drainage water Green? [ ] Yes [ ] No

[ ] Stream/shoreline restoration Green? [ ] Yes [ ] No

[ ] Wetland creation or restoration Green? [ ] Yes [ ] No

[ ] Other:

TAKE NOTE OF THE FOLLOWING WHEN COMPLETING THE REMAINDER OF THE APPLICATION

Submittal of requested documentation is necessary for the evaluation of the application. Failing to submit requested documents can significantly impact the final score and rank of the project.

When providing additional information on a separate page, please include the applicant and project

name, and refer to the corresponding section number and heading of the application as specified.

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II. THRESHOLD CRITERIA (Please answer the questions below and provide supporting documentation where requested as a clearly labeled attachment to the application.)

a. Project must meet one of the following definitions to be eligible for funding. Select the appropriate

“eligible” category below.

[ ] Project is a publicly-owned treatment works1. Public entities include local governments, State agencies, inter-government agencies, sanitary commissions/districts within Maryland that are recognized as public entities under Maryland State law. Public entities do not include Federal government. This project must meet the requirements in Section II.b and II.c. If seeking WQRLF funding, it must also meet the requirements in Section II.d and II.e.

[ ] Project is a publicly-owned non-treatment works2. Public entities include local governments, State agencies, inter-government agencies, sanitary commissions/districts within Maryland that are recognized as public entities under Maryland State law. Public entities do not include Federal government. This project is exempt from the requirements of Sections II.b, II.c, and II.d, but must meet the requirement in Section II.e, if applying for WQRLF.

[ ] Project is a privately-owned non-treatment works2. This project is exempt from the requirements in Sections II.b, II.c, II.d, and II.e; however, it is not eligible for Bay Restoration Fund Wastewater Grant unless the private entity is partnering with a local government that has a system of charges and that local government partner is the applicant. If project does not fall into one of the above-mentioned categories, and the applicant believes that the project is eligible for MDE funding, contact Elaine Dietz at elaine.dietz@maryland.gov or (410) 537-3908.

b. Is the sewerage treatment works project (and the area served by it) located entirely within a Priority Funding

Area (PFA) as shown on the PFA map created by Maryland Department of Planning (MDP) based on the local map?

[ ] Yes – Attach a color copy of the current MDP PFA map that shows the PFAs and PFA Comment Areas, if any, in the vicinity of the project and mark the location of the project (including linear features) and its service area on the MDP map. See Supplementary Mapping Instructions for help.

[ ] No – Provide an explanation on a separate page. If the project and the area served by it are not located entirely within a PFA, the project will not be eligible for financial assistance until the PFA consistency issue is resolved. For guidance on PFA exception, go to the PFA Exception Procedure or call Janice Outen, MDE Water Resources Planning Unit, at (410) 271-8893. (Note: If an exception has already been granted, provide a copy of the exception determination.)

c. Is the sewerage treatment works project included in (or amended to) the MDE-approved County Water

& Sewer Plan and consistent with the local Land Use Plan?

[ ] Yes – Provide a copy of the applicable page(s) from the current MDE-approved County Water & Sewer Plan and approved amendments. In addition, provide a color copy of the service area map and fill in the information below. Date of MDE-approved County Water & Sewer Plan: _____________________________________________ Applicable page number(s): ________________________________________________________________ Title and date of MDE-approved service area map: ______________________________________________ Date of MDE approval letter for an amendment: _________________________________________________ [ ] No – If no, the project is ineligible for MDE funding.

1 Treatment works include projects such as those that provide for advanced wastewater treatment (BNR or ENR), combined sewer overflow (CSO)/sanitary sewer overflow (SSO) correction, storm sewers involved in the separation of CSOs, aging sewer system rehabilitation or replacement, sewer extension to sewerage treatment facilities for septic system communities, non-hazardous landfill leachate conveyance and/or treatment, and sewerage system energy conservation, security, water conservation/efficiency/reuse.

2 Non-treatment works are those that manage, reduce, treat, or recapture stormwater or subsurface drainage water (such as BMPs required by Municipal Separate Storm Sewer System (MS4) permit, Stormwater General Discharge Permit (e.g., 12SW, 14GP, etc), and non-hazardous solid waste landfill capping. Other nonpoint source pollution prevention practices identified under Federal Clean Water Act Section 319 Plan for Maryland (e.g., leaking storage tanks, agricultural BMPs, septic system repairs) that are not stormwater BMPs may be funded through the MWQFA Linked Deposit (Bank Loan) Program. For additional information, see www.mde.maryland.gov/wqfa.

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d. Is there a Fiscal Sustainability Plan for the publicly-owned treatment works projects proposed for WQRLFfunding? A Fiscal Sustainability Plan that includes an inventory of critical assets; an evaluation of the condition and performance of inventoried assets; certification of evaluation/implementation of water and energy conservation efforts; and an asset maintenance, repair, and replacement schedule must be developed and submitted to MDE prior to WQRLF loan closing. [ ] Applicant certifies completion of the WQRLF Fiscal Sustainability Plan requirements. The Fiscal Sustainability Plan is included with this application. [ ] Applicant will develop and submit prior to loan closing the required Fiscal Sustainability Plan.

[ ] Applicant certifies that this application is for WQRLF funding of a non-treatment works; therefore, Fiscal Sustainability Plan is not required.

[ ] Not applicable - application is for grant funding only.

e. Has a Preliminary Engineering Report been completed that includes a Cost and Effectiveness Analysis for thepublicly-owned treatment works projects proposed for WQRLF funding? A Cost and Effectiveness Analysisincluding the study and evaluation of the cost and effectiveness of the processes, materials, techniques, andtechnologies for carrying out the proposed project or activity and selection (to the maximum extent practicable)of a project or activity that maximizes the potential for efficient water use, reuse, recapture, and conservation, andenergy conservation should be developed prior to initiating design and report must be submitted to MDE prior toWQRLF closing. See Minimum Funding Participation Requirements for Preliminary Engineering Reports (PER) foradditional information.[ ] Applicant certifies completion of the WQRLF Cost and Effectiveness Analysis requirement. TheCost and Effectiveness Analysis is included with this application.

[ ] Applicant will develop and submit prior to loan closing the required Cost and Effectiveness Analysis.

[ ] Applicant certifies that this application is for WQRLF funding of a privately-owned non-treatmentworks; therefore, a Cost and Effectiveness Analysis is not required.[ ] Not applicable - application is for grant funding only.

III. PROJECT PURPOSE AND SUMMARY (Provide the following information in the requested format. On a separate pagetitled “Project Purpose and Summary,” provide a brief description of the project by answering the following questions in the order shown (labeled III.a through III.c).

a. What is the proposed project? Include the existing and proposed capacities, length and size of sewer pipes,number of manholes, location of service area, drainage acreage, linear footage, etc. (Note: If you have determinedthat the project fully or partially qualifies as a green project based on the EPA guidance, include reference to thespecific section of the guidance as part of the project description.)

b. What is the purpose of the project, why is the project needed, and what problem is being corrected?

c. Has the project been previously submitted to MWQFA for funding consideration? If so, by what projectname, has the scope of work changed since that submittal (explain how, if so), and was the projectselected to receive funding?

IV. PROJECT SUPPORTING DOCUMENTS (Please answer the questions below and provide supporting documentation asrequested. Failing to submit the requested documents can significantly impact the final score and rank of the project.)

a. Is the project required due to a final administrative/judicial order, MS4 Permit, or to comply with morerestrictive NPDES/State Groundwater Discharge Permit limits?

[ ] Yes – Summarize on a separate page and provide a copy of the administrative/judicial order (including theadministrative/judicial order number) or permit.

[ ] No

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b. Is the project necessary to address a public health issue (e.g., contamination of drinking source water supply, surface water, or groundwater)?

[ ] Yes – Summarize on a separate page and provide documentation of contamination, contaminant levels, and frequency of occurrence from an approving authority.

[ ] No

c. Can the project be credited toward a local Watershed Implementation Plan (WIP) for the Chesapeake Bay Total

Maximum Daily Load?

[ ] Yes – Summarize on a separate page and provide pertinent section(s) of local WIP.

[ ] No

d. Does the project benefit the water quality of Maryland’s Coastal Bays consistent with the Comprehensive Conservation Plan for Maryland’s Coastal Bays?

[ ] Yes – Summarize on a separate page and provide pertinent section(s) of the aforementioned Conservation Plan.

[ ] No

e. Does the project provide for sustainability? (Please check all that apply. For every box checked, supporting

documentation must be provided in order to receive credit. See Supplementary Mapping Instructions for help.)

[ ] Project Benefits Existing Sustainable Community Needs (check all that apply): [ ] Project provides for < 20% increase of Equivalent Dwelling Units (EDUs) served as calculated in Section V.a. [ ] Project provides for < 20% increase of design capacity at WWTP or “decentralized” wastewater system. [ ] Project is located within one-half (½) mile of a transit station. [ ] Project is located within a Base Realignment and Closure (BRAC) Zone. [ ] Project is part of a Brownfield property redevelopment. [ ] Project is located within a Department of Housing and Community Development (DHCD)-designated Sustainable Community (inc. Community Legacy areas) or a DHCD-Designated Maryland Main Street.

[ ] Project implements reuse/recycling of stormwater, treated wastewater effluent, or wastewater treatment products (e.g., biosolids/biogas for energy generation).

[ ] Project is located in an Environmental Benefits District.

[ ] Project will provide for energy use reduction or alternate energy generation.

V. SYSTEM INFORMATION

Sewerage System Name (if applicable):

Treatment Facility Name: NPDES #:

(For collection/conveyance system projects, enter name and NPDES # of receiving WWTP)

System/Facility Owner:

Owner Address:

Contact Person: Phone Number: Ext:

Email Address:

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a. Insert population information in the table below:

Description # of users (Population)

# of households (EDUs)*

# of current users served by system (2018) 0

# of current users served by proposed project (2018) 0

# of future users served by the proposed project (2038) 0

* EDUs = Equivalent Dwelling Units. The shaded fields are automatically calculated

% Difference: (Automatically calculated once data is inserted in table shown above)

b. System size (for purpose of determining WQRLF subsidy eligibility): [ ] Small - the project will benefit/serve a current population of <10,000 AND that same population will bear debt on loan taken for the project (e.g., back-charge)*.

Name of Small Entity: Population:

[ ] Large – a current population of ≥10,000 will bear debt on loan taken for the project (e.g, back-charge), whether the project benefits/serves a current population of <10,000 or ≥10,000.

Name of Large Entity: Population: [ ] Not Applicable – application is for Bay Restoration Wastewater Grant funding only.

VI. PROJECT SCHEDULE AND CURRENT STATUS (Provide the project schedule and architectural/engineering (A/E) firm below.)

Current project status: [ ] Planning [ ] Design [ ] Bidding

Phase Start (Month/Year) Completion (Month/Year) Percent Completion

Planning

Design

Bidding

Construction*

*Construction projects must be in construction by December 31, 2019 to be considered for funding.

A/E Firm:

Contact:

Phone: Ext:

[ ] Planning OR [ ] Design

Email Address:

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]

VII. PROJECT FUNDING (Provide sources and uses of funding for the project and identify use(s) of the requested funding. Identify revenue sources for loan repayment, if seeking loan funding, on a separate page.)

a. Identify the Project Funding Sources for the project in the tables below:

MDE Funding Request (request for FY19) Amount Description

Total Amount Requested x. Full amount requested from MDE, regardless of funding source

Green Component(s) Amount How much of total above is green-eligible (as ID'd in Section III.a)?

Other Funding Amount

MDE Grant Amount(s) Previous funding* MDE Loan Amount(s) Previous funding*

Funds Secured?

Applicant* [ ] Yes [ ] No

U.S. Corps of Engineers * [ ] Yes [ ] No

Federal (EPA) STAG/SAAP* [ ] Yes [ ] No

USDA Rural Development * [ ] Yes [ ] No

CDBG (DHCD)* [ ] Yes [ ] No

Miscellaneous*: [ ] Yes [ ] No

Other Funding Total y. $ 0 Total of all Prior and Additional Funding Sources

* Include costs of planning/design/construction already completed.

Source Total (x. + y.) $ 0

Total Amount requested from MDE plus Other Funding Total should match the Budget Total in VII.b.

b. Identify the cost-breakout of the budget (Project Budget) in the table below:

Project Funding Use(s)

Amount

Are MDE Grant and/or Loan Funds Requested

for this Line Item?

Is this line item already funded by an "Other Funding" source

(above)? A/E Planning* [ ] Yes [ ] No [ ] Yes [ ] No A/E Design* [ ] Yes [ ] No [ ] Yes [ ] No A/E Construction Management* [ ] Yes [ ] No [ ] Yes [ ] No Construction* [ ] Yes [ ] No [ ] Yes [ ] No Land* [ ] Yes [ ] No [ ] Yes [ No Contingency* [ ] Yes [ ] No [ ] Yes [ ] No Administrative* [ ] Yes [ ] No [ ] Yes [ ] No Other*: [ ] Yes [ ] No [ ] Yes [ ] No

Budget Total

$ 0 Total should match the Source Total in VII.a.

* Include costs of planning/design/construction already completed.

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VIII. PROJECT NUMERIC BENEFIT/COST-EFFECTIVENESS (Please supply data for the project in the appropriate section below. Go to Step 1 of Section I-A of the Integrated Project Priority System for Water Quality Capital Projects for additional instructions.

Provide for all projects:

Total Nitrogen (TN) Removed (lbs/yr):

Capital cost $/lb TN per year reduced:

(Total project cost $/20 years)/lb per year TN reduction

Complete as applicable based on project scope:

Linear Feet (lf) of Sewer Main/Rehab.: S e w e r Main Diameter (inches):

Current Discharge Flow (mgd): Stormwater Drainage Area (acres): % Imperviousness of Drainage of Acres being treated by project: Land Use: Wetland Created or Restored (acres): Stream Restored (linear feet):

Landfill Capping (acres):

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I CERTIFY I AM AN AUTHORIZED OFFICIAL PERMITTED TO SIGN AND SUBMIT THIS APPLICATION ON BEHALF OF THE APPLICANT. I FURTHER CERTIFY ALL INFORMATION IN THIS APPLICATION AND ATTACHED MATERIALS ARE TRUE AND CORRECT.

Name: Title:

Authorized Official Signature: Date:

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See cover page for Application Submission instructions and general information.